Look before you leap: Society will bear substantial costs if state legalizes marijuana

Public media have given significant attention over the past several years to the work of activists who wish to legalize marijuana. As a result of their efforts, a number of states have begun to implement laws, which purport to make marijuana available to people with a range of health problems.

Colorado and Washington now have laws that permit adults to openly grow, sell and possess marijuana; no other jurisdictions in the world have implemented this level of tolerance.

The success has come in part by emphasizing potential benefits of marijuana and minimizing likely risks.

Therefore, before New York State jumps on the bandwagon, it is essential that the full picture of risks and benefits is discussed and incorporated into wise policy making.

Three types of arguments have been put forth to support legalizing marijuana: health, economic and legal.

Health: Risks outweigh benefits

First, “marijuana has proven health benefits and is safe.” Typically, stories report on individuals who believe that smoking marijuana has helped their chronic pain or spasms. While important, the experience of isolated cases may not generalize what will happen to others: benefit or risk.

To date, no large-scale and systematic studies have shown major benefits of smoked marijuana. In fact, benefits are often limited by a significant incidence of central nervous system side effects, such as hallucinations and uncoordination. A doctor cannot recommend smoked marijuana based on the strength of medical studies documenting reasonable medical benefit with reasonable side effect risks, as there are no such studies.

Advocates often repeat their belief that marijuana has been available for thousands of years and is known to be safe. In fact, the rest of the story, based on a growing body of scientific literature, proves otherwise. In short-term use, it impairs coordination, impairing driving and other complex tasks. Several studies have shown that it is a significant contributor to automobile accidents, the rate of which has risen in Colorado since the state has promulgated medical marijuana.

With long-term use, marijuana can be physically addicting in some people. One in 10 adults who try it will go on to develop patterns of compulsive use, inability to limit their use and significant negative life events. Potential effects in teens are more troublesome, where the likelihood of dependency increases to one in six. Frequent smoking has been shown to affect rates of psychosis, depression, anxiety, lung function, school and work performance and newborn weight. The statement that marijuana is safer than alcohol or tobacco may be partly true; but circulating via the lungs several hundred chemicals, many of known toxic potential, most of unknown effects, cannot be safe.

Most reports of the benefits of marijuana focus on severe debilitating conditions such as end-stage cancer or unremitting pain and hope to focus our compassion so that we will make this “magic medicine” marijuana particularly accessible to those who have no other treatment hope. In such cases, even modest benefit would seem to outweigh nearly all risks. In fact, in areas that have reported their experience, the vast majority of people who are authorized to possess medical marijuana do not have these types of conditions. In fact, in states that approve medical marijuana, folks believe that marijuana has improved almost everything from ADHD to insomnia, leaving the risk-benefit balance unclear. Thus it seems apparent that proposing to use marijuana as a medicine opens the door to nearly any problem, making nearly everyone eligible.

More importantly, underreporting of risk will likely contribute to use by people who have no health problems. It has been shown that perceived risk is an important contributor to the decision to use; if the risk is minimal, why not? While firm data are not yet available from medical marijuana areas, it seems reasonable that more people will use marijuana and be exposed to its associated risks.

Recently, The Buffalo News reported that the director of a national marijuana advocacy group is promoting that marijuana should be regulated like other herbs, which are only superficially monitored. However, no other herb has such known health risks. This proposal highlights the advocates’ goal of providing the least possible restrictions on marijuana regulation. No doubt commercialization of distribution of marijuana will magnify that trend.

Economic: Legalization unlikely to boost economy

The second group of justifications often raised in support of expanded marijuana use is that it will improve the economy through new jobs and taxes. The RAND research group raised a number of critical economic questions undermining the credibility of these assertions. For example, how expensive will it be to create the required extensive regulatory structure needed to support new tax collectors, safety monitoring and health side effects? Many of the new jobs will be relatively low paying and unskilled and therefore not likely to add much to our economic progress. While long-term economic projections for marijuana are difficult, it is well-established that the revenues generated to governments from the sale of alcohol and tobacco do not support the billions of additional costs to society that result from the sale of these substances.

It is also said that by removing the profits of illegal marijuana sales and distribution, the costs of enforcement against drug cartels and police interdiction will go down. These benefits may not be substantial either, since it is estimated that only a small percentage of the profits to the cartels comes from marijuana. If they dropped out of the marijuana business completely, it seems likely they would find other ways to maintain their bottom line. Also, it is possible that expanded marijuana use will also expand other legal problems that police will need to deal with, such as an increase in driving under the influence of drugs. Thus, for marijuana, it seems reasonable to expect that while some entrepreneurs may end up making large profits, the costs to the rest of society will be substantial.

Legal: Advocacy groups simplify complex problem

A third set of justifications related to the impact of implementing current marijuana laws relates to civil rights and the criminal justice system. Advocacy groups often report on large numbers of people convicted and incarcerated for simply possessing marijuana, again oversimplifying a complex problem.

For example, in New York State, an individual who possesses moderate amounts of marijuana for personal use in a civil violation is subject to fines, but not incarceration. Those who are in jail for marijuana-related crimes are there either for sales or other crimes, but not the simple possession of marijuana. Unique to our state, high rates of “stop and frisk,” especially in New York City, appear to impact minorities disproportionately. This is an area of concern and should be subjected to further legal review. Having a punishment that is appropriate to the crime should remain a cornerstone.

Advocates say widespread use of marijuana in contradiction to laws undermines public support for the legal system. But the vast majority of people do not smoke marijuana. By overstating prevalence of use, they are supporting teen misinformation; “everyone does it, so why can’t I?”

Advocates also state that the choice to use marijuana, like other individual decisions, should be purely personal, not subject to governmental restraints. Most of us would agree that government should interfere with personal behavior only by exception. However, when such individual behavior affects us all, such as driving while under the influence, as a society we have a right to attempt to modify individual behavior. Further, we are all affected by unnecessary health care costs of marijuana abuse.

It is also stated that making marijuana illegal has not reduced levels of marijuana use. “Prohibition of alcohol failed, and so it has with pot.” In fact, alcohol prohibition did reduce alcohol abuse and health consequences of drinking, such as cirrhosis. It was repealed, however, due to lack of strong public support and impact on other criminal activity.

Since it is well-documented that availability, societal attitudes and perceived levels of risk of abusable substances predict levels of use, it seems likely that the efforts of marijuana advocates will increase use of marijuana. An extensive body of studies has shown that the number of people who use mood-altering substances is closely related to the interaction of several identifiable individual and social factors. These include price, availability, perceived risk and the generally held public view of the substance. Current proposals – potentially decreasing the price, making marijuana more readily available and enhancing societal acceptance of it – reduce the protective factors. These effects are especially important for vulnerable populations: teens and those with mental health issues and/or behavioral problems.

Admittedly, our current societal response to marijuana oversight is not optimal either. The past 10 years of rising rates of marijuana use have undermined the prior 20 years of major decline of use. The strong emphasis and expense of supply reduction has not been sufficiently successful. However, radically changing laws, regulations and how they are implemented is not the right direction.

Have we forgotten the advice that parents and others have given us? Just because everyone else does it, doesn’t mean it is a good idea for us. However, knowledge gained from prior experience does provide a path to improvement. For example:

• Expand a public health campaign to accurately inform, in culturally and age-appropriate ways, the risks of marijuana use and abuse.

• Expand relevant research to identify likely benefits of chemical components of marijuana, resulting in products of known safety, dosage, routes of delivery and side effects.

• Expand the use of appropriate interventions, coordinated with legal sanctions, for those with impairment related to sustained marijuana use, such as via drug courts.

• Re-evaluate the role and scope of demand reduction efforts to make them more effective and less intrusive.

Robert Whitney, M.D., is the former medical director for the Addictions Unit at Erie County Medical Center. He has been a board member for the Erie County Council for the Prevention of Alcohol and Substance Abuse since 2005 and the public policy committee chairman for several years.